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ICD-10 Guide
ICD-10 CodesK76.1

K76.1

Billable

Chronic passive congestion of liver

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K76.1 is a billable code used to indicate a diagnosis of chronic passive congestion of liver.

Key Diagnostic Point:

Chronic passive congestion of the liver, also known as hepatic congestion, occurs when blood flow to the liver is impeded, often due to heart failure or other conditions affecting venous return. Clinically, patients may present with symptoms such as abdominal discomfort, hepatomegaly, and signs of portal hypertension, including ascites and splenomegaly. The liver anatomy involved includes the hepatic veins, portal vein, and sinusoids, which can become engorged with blood due to the increased pressure. Over time, chronic passive congestion can lead to liver fibrosis and potentially progress to cirrhosis if the underlying cause is not addressed. Diagnosis typically involves imaging studies such as ultrasound or CT scans, along with laboratory tests to assess liver function. A thorough patient history and physical examination are essential to identify the underlying etiology of the congestion.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires understanding of underlying cardiovascular conditions.
  • Treatment complexity: Management often involves addressing the primary cause, which may require multidisciplinary approaches.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate coding to differentiate from other liver conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other liver diseases.
  • Documentation gaps: Incomplete records regarding the underlying causes.
  • Billing challenges: Potential denials if the relationship between heart failure and liver congestion is not clearly documented.

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic passive congestion of the liver has significant clinical implications, as it can lead to serious complications such as liver fibrosis and cirrhosis. The condition is often seen in populations with high rates of heart disease, impacting healthcare utilization patterns due to increased hospitalizations and the need for specialized care. Understanding the epidemiology of K76.1 can help healthcare providers implement preventive measures and improve patient outcomes through better management of underlying cardiovascular conditions.

ICD-9 vs ICD-10

Chronic passive congestion of the liver has significant clinical implications, as it can lead to serious complications such as liver fibrosis and cirrhosis. The condition is often seen in populations with high rates of heart disease, impacting healthcare utilization patterns due to increased hospitalizations and the need for specialized care. Understanding the epidemiology of K76.1 can help healthcare providers implement preventive measures and improve patient outcomes through better management of underlying cardiovascular conditions.

Reimbursement & Billing Impact

Reimbursement may be affected by the clarity of the documentation linking the liver condition to heart failure or other systemic issues. Common denials can occur if the documentation does not adequately support the diagnosis or if there is a lack of evidence for the chronic nature of the condition. Best practices include thorough clinical notes, imaging reports, and lab results that clearly outline the patient's status and treatment plan.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K76.1?

K76.1 specifically covers chronic passive congestion of the liver, which can be caused by conditions such as congestive heart failure, hepatic vein obstruction, or other systemic diseases that impair venous return.

When should K76.1 be used instead of related codes?

K76.1 should be used when there is clear evidence of chronic passive congestion due to underlying cardiovascular issues, differentiating it from acute conditions or other liver diseases that may present with similar symptoms.

What documentation supports K76.1?

Documentation should include a detailed patient history, physical examination findings, imaging results showing liver congestion, and any relevant laboratory tests indicating liver function impairment.